Urological Research

, Volume 21, Issue 3, pp 169–173 | Cite as

Pathophysiology of incomplete renal tubular acidosis in recurrent renal stone formers: evidence of disturbed calcium, bone and citrate metabolism

  • P. J. Osther
  • J. Bollerslev
  • A. B. Hansen
  • K. Engel
  • P. Kildeberg
Original Articles


Urinary acidification, bone metabolism and urinary excretion of calcium and citrate were evaluated in 10 recurrent stone formers with incomplete renal tubular acidosis (RTA), 10 recurrent stone formers with normal urinary acidification (NUA) and 10 normal controls (NC). Patients with iRTA had lower plasma standard bicarbonate after fasting (P<0.01) and lower urinary excretion of titratable acid (P<0.05) and citrate (P<0.01) compared with NUA patients and NC, and higher urinary excretion of ammonia (P<0.05) compared with NC (P<0.05). Hypercalciuria was found in 6 of 10 patients with iRTA compared with 3 of 10 with NUA, and O of 10 NC. The citrate/calcium ratio in urine was significantly reduced in iRTA compared with the value in NUA (P<0.01), and in NUA compared with NC (P<0.05). Biochemical markers of bone formation (serum osteocalcin) and bone resorption (urinary hydroxyproline) were significantly increased in iRTA compared with NUA and NC (P<0.01), indicating increased bone turnover in stone formers with iRTA. Stone formers with iRTA thus presented with disturbed calcium, bone and citrate metabolism-the same metabolic abnormalities which characterize classic type 1 RTA. Mild non-carbonic acidosis during fasting may be a pathophysilogical factor of both nephrolithiasis and disturbed bone metabolism in stone formers with iRTA

Key words

Bone turnover Calcium Citrate Renal stones Renal tubular acidosis 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Backman U, Danielson BG, Johanson G, Ljunghall S, Wikström B (1980) Incidence and clinical importance of tubular defects in recurrent renal stone formers. Nephron 25:96Google Scholar
  2. 2.
    Baginski ES, Foà PP, Zak B (1967) Microdetermination of inorganic phosphate, phospholipids, and total phosphate in biological materials. Clin Chem 13:326Google Scholar
  3. 3.
    Battle D (1983) Renal tubular acidosis. Med Clin North Am 67:859Google Scholar
  4. 4.
    Buckalew VM Jr (1985) Nephrolithiasis in renal tubular acidosis. J Urol 141:731Google Scholar
  5. 5.
    Buckalew VM Jr, Caruana RJ (1985) The pathophysiology of distal (type 1) renal tubular acidosis. In: Gonick HC, Buckalew VM Jr. (eds) Renal tubular disorders: pathophysiology, diagnosis, and management. Dekker, New York, p 357Google Scholar
  6. 6.
    Buckalew VM Jr, McCurdy DK, Ludwig GD, Chaykin LB, Elkinton JR (1968) Incomplete renal tubular acidosis: physiologic studies in three patients with a defect in lowering urine pH. Am J Med 48:32Google Scholar
  7. 7.
    Caruana RJ, Buckalew VM Jr (1988) The syndrome of distal (type 1) renal tubular acidosis. Medicine (Baltimore) 67:84Google Scholar
  8. 8.
    Gault MH, Parfrey PS, Robertson WG (1988) Idiopathic calcium phosphate nephrolithiasis. Nephron 48:265Google Scholar
  9. 9.
    Jørgensen K (1957) Trimetric determination of the net excretion of acid/base in urine. Scand J Clin Lab Invest 9:287Google Scholar
  10. 10.
    Kildeberg P (1983) Acid-base status of biological fluids: amount of acid, kind of acid, anion-cation difference, and buffer value. Scand J Clin Lab Invest 43:103Google Scholar
  11. 11.
    McSherry E, Morris RC Jr (1978) Attainment and maintenance of normal stature with alkali therapy in infants and children with classic renal tubular acidosis. J Clin Invest 61:509Google Scholar
  12. 12.
    Nicar MJ, Skurla C, Sakhaee K, Pak CYC (1983) Low urinary citrate excretion in nephrolithiasis. Urology 21:8Google Scholar
  13. 13.
    Osther PJ, Hansen AB, Røhl HF (1988) Renal acidification defects in medullary sponge kidney. Br J Urol 61:392Google Scholar
  14. 14.
    Osther PJ, Hansen AB, Røhl HF (1989) Screening renal stone formers for distal renal tubular acidosis. Br J Urol 63:581Google Scholar
  15. 15.
    Parks JH, Coe FL (1986) A urinary calcium-citrate index for the evaluation of nephrolithiasis. Kidney Int 30:85Google Scholar
  16. 16.
    Pødenphant J, Larsen N-E, Christiansen C (1984) An easy and reliable method for determination of urinary hydroxyproline. Clin Chim Acta 142:145Google Scholar
  17. 17.
    Pohlman T, Hruska KA, Menon M (1977). Renal tubular acidosis. J Urol 132:431Google Scholar
  18. 18.
    Preminger GM, Sakhaee AK, Skurla C, Pak CYC (1985) Prevention of recurrent calcium stone formation with potassium citrate therapy in patients with distal renal tubular acidosis. J Urol 134:20Google Scholar
  19. 19.
    Richards P, Chamberlain MJ, Wrong OM (1972) Treatment of osteomalacia of renal tubular acidosis by sodium bicarbonate alone. Lancet II:994Google Scholar
  20. 20.
    Rodríguez-Soriano J, Vallo A, Castillo G, Oliveros R (1985) Pathophysiology of primary distal renal tubular acidosis. Int J Pediatr Nephrol 6:77Google Scholar
  21. 21.
    Schneeberger W, Hesse A, Vahlensieck W (1992) Recurrent nephrolithiasis in renal tubular acidosis: metabolic profiles, therapy and course. Urol Res 20:98Google Scholar
  22. 22.
    Sebastian A, Morris RC Jr (1977) Renal tubular acidosis. Clin Nephrol 7:216Google Scholar
  23. 23.
    Seldin DW, Wilson JD (1966) Renal tubular acidosis. In: Stanbury JB, Wyngaarden JB, Fredrickson DS (eds) The metabolic basis of inherited disease. McGraw-Hill, New York, p 1230Google Scholar
  24. 24.
    Steinicke T, Mosekilde L, Christensen MS, Melsen F (1989) A histomorphometric determination of iliac bone remodeling in patients with recurrent renal stone formation and idiopathic hypercalcuria. APMIS 97:309Google Scholar
  25. 25.
    Tannen RL, Falls WF, Brackett NC (1975) Incomplete renal tubular acidosis: some clinical and physiological features. Nephron 15:111Google Scholar
  26. 26.
    Warty VS, Busch RP, Virji MA (1984) A kit for citrate in foodstuffs adapted for assay of serum and urine. Clin Chem 30:1231Google Scholar
  27. 27.
    Williams G, Chisholm GD (1976) Stone screening and follow-up are necessary? Br J Urol 47:745Google Scholar
  28. 28.
    Wrong O, Davies HEF (1959) The excretion of acid in renal disease. Q J Med 28:259Google Scholar
  29. 29.
    Wrong OM, Feest TG (1980) The natural history of distal renal tubular acidosis. Contrib Nephrol 21:137Google Scholar

Copyright information

© Springer-Verlag 1993

Authors and Affiliations

  • P. J. Osther
    • 1
  • J. Bollerslev
    • 2
  • A. B. Hansen
    • 3
  • K. Engel
    • 3
  • P. Kildeberg
    • 4
  1. 1.Department of UrologyOdense University HospitalOdenseDenmark
  2. 2.Department of Medical EndocrinologyOdense University HospitalOdenseDenmark
  3. 3.Department of Clinical ChemistryOdense University HospitalOdenseDenmark
  4. 4.Department of PediatricsOdense University HospitalOdenseDenmark

Personalised recommendations